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1/32. Posttraumatic subdural hygroma: CT findings and differential diagnosis.

    Subdural hygroma is a cerebrospinal fluid accumulation in the subdural space. It is an epiphenomenon of head injury. CT is the preferred diagnostic imaging modality. Differential diagnosis has to be made with chronic subdural hematoma, and atrophy with enlargement of the subarachnoid space. As time goes by, subdural hygroma either resolves, or it becomes a chronic subdural hematoma. Neurosurgical evacuation is only required when mass effect creates neurologic symptoms. ( info)

2/32. Traumatic basilar artery dissection in a child: need for anticoagulation?

    dissection of a cerebral blood vessel is a rare complication of acute neurotrauma with a high incidence of morbidity and mortality. We report on a case of a pediatric patient with severe neurological symptoms in whom angiography showed evidence of a basilar artery dissection. The patient was heparinized and recovered uneventfully. ( info)

3/32. Case study: bipolar disorder after head injury.

    A case of bipolar disorder subsequent to a mild head injury in a 15-year-old girl is reported. review of the literature indicates that this is an extremely rare outcome. Lack of adequate follow-up studies makes it difficult to accurately predict type and severity of psychiatric outcome. Assessment and management involves ongoing consideration of both organic and psychosocial factors even after initial negative investigations. ( info)

4/32. Fatal progression of posttraumatic dural arteriovenous fistulas refractory to multimodal therapy. Case report.

    The authors report the case of a man who suffered from progressive, disseminated posttraumatic dural arteriovenous fistulas (DAVFs) resulting in death, despite aggressive endovascular, surgical, and radiosurgical treatment. This 31-year-old man was struck on the head while playing basketball. Two weeks later a soft, pulsatile mass developed at his vertex, and the man began to experience pulsatile tinnitus and progressive headaches. magnetic resonance imaging and subsequent angiography revealed multiple AVFs in the scalp, calvaria, and dura, with drainage into the superior sagittal sinus. The patient was treated initially with transarterial embolization in five stages, followed by vertex craniotomy and surgical resection of the AVFs. However, multiple additional DAVFs developed over the bilateral convexities, the falx, and the tentorium. Subsequent treatment entailed 15 stages of transarterial embolization; seven stages of transvenous embolization, including complete occlusion of the sagittal sinus and partial occlusion of the straight sinus; three stages of stereotactic radiosurgery; and a second craniotomy with aggressive disconnection of the DAVFs. Unfortunately, the fistulas continued to progress, resulting in diffuse venous hypertension, multiple intracerebral hemorrhages in both hemispheres, and, ultimately, death nearly 5 years after the initial trauma. Endovascular, surgical, and radiosurgical treatments are successful in curing most patients with DAVFs. The failure of multimodal therapy and the fulminant progression and disseminated nature of this patient's disease are unique. ( info)

5/32. intracranial pressure within a developing intracerebral haemorrhage.

    We report the time course of intracranial pressure within a developing intracerebral haemorrhage. Simultaneous readings of intracranial pressure were obtained from a contralateral parenchymal monitor and ventricular fluid pressure monitor. This recording demonstrates the existence of large pressure gradients in patients with expanding mass lesions. ( info)

6/32. Reorganisation of the sensorimotor cortex after early focal brain lesion: a functional MRI study in monozygotic twins.

    Sensorimotor cortical reorganization after early brain lesions was studied by means of fMRI in two pairs of monozygotic twins, in each of which one member had a focal brain injury. This offered a unique opportunity to reduce the wide intersubject variability of the controls often found in similar studies. Activation images were acquired during a motor task (sequential opposition finger movements) and a sensory task (passive brushing of palm and fingers). During the tasks with the recovered hand, constant findings in the lesioned subjects were the activation of the undamaged areas adjacent to lesion site and the activation of the ipsilateral sensorimotor cortex. Bilateral activation of the primary sensorimotor cortex was never observed in the healthy co-twin controls. ( info)

7/32. Falcotentorial meningioma accompanied by temporal lobe hematoma.

    We report a case of a falcotentorial meningioma accompanied by hematoma in the temporal lobe. A healthy 51 year-old-female with no history of hypertension presented with sudden onset of consciousness disturbance and right hemiparesis. Computed tomography revealed a hematoma 5.5 cm in diameter surrounded by thick edematous brain in the left temporal lobe and a tumor 3.5 cm in diameter in the pineal region. Bilateral carotid angiography detected occlusion of the Galenic vein and straight sinus. No causative abnormality of hemorrhage was apparent. However, the left basal vein of Rosenthal had disappeared, and anastomotic venous channels could be observed in the medial left temporal lobe, contiguous to the hematoma. Emergency craniotomy failed to detect any abnormality which could cause hemorrhage in the brain parenchyma surrounding the hematoma. Subtotal removal of the tumor, histologically diagnosed as fibrous meningioma, was achieved three months later employing an occipital transtentorial approach. Venous congestion caused by compression due to the tumor was considered to be one of possible causes of the hemorrhage. ( info)

8/32. Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury.

    OBJECT: Progressive intracranial hemorrhage after head injury is often observed on serial computerized tomography (CT) scans but its significance is uncertain. In this study, patients in whom two CT scans were obtained within 24 hours of injury were analyzed to determine the incidence, risk factors, and clinical significance of progressive hemorrhagic injury (PHI). methods: The diagnosis of PHI was determined by comparing the first and second CT scans and was categorized as epidural hematoma (EDH), subdural hematoma (SDH), intraparenchymal contusion or hematoma (IPCH), or subarachnoid hemorrhage (SAH). Potential risk factors, the daily mean intracranial pressure (ICP), and cerebral perfusion pressure were analyzed. In a cohort of 142 patients (mean age 34 /- 14 years; median glasgow coma scale score of 8, range 3-15; male/female ratio 4.3: 1), the mean time from injury to first CT scan was 2 /- 1.6 hours and between first and second CT scans was 6.9 /- 3.6 hours. A PHI was found in 42.3% of patients overall and in 48.6% of patients who underwent scanning within 2 hours of injury. Of the 60 patients with PHI, 87% underwent their first CT scan within 2 hours of injury and in only one with PHI was the first CT scan obtained more than 6 hours postinjury. The likelihood of PHI for a given lesion was 51% for IPCH, 22% for EDH, 17% for SAH, and 11% for SDH. Of the 46 patients who underwent craniotomy for hematoma evacuation, 24% did so after the second CT scan because of findings of PHI. Logistic regression was used to identify male sex (p = 0.01), older age (p = 0.01), time from injury to first CT scan (p = 0.02), and initial partial thromboplastin time (PTT) (p = 0.02) as the best predictors of PHI. The percentage of patients with mean daily ICP greater than 20 mm Hg was higher in those with PHI compared with those without PHI. The 6-month postinjury outcome was similar in the two patient groups. CONCLUSIONS: Early progressive hemorrhage occurs in almost 50% of head-injured patients who undergo CT scanning within 2 hours of injury, it occurs most frequently in cerebral contusions, and it is associated with ICP elevations. Male sex, older age, time from injury to first CT scan, and PTT appear to be key determinants of PHI. Early repeated CT scanning is indicated in patients with nonsurgically treated hemorrhage revealed on the first CT scan. ( info)

9/32. Delayed rupture of traumatic intracranial pseudoaneurysm in a child following gunshot wound to the head.

    BACKGROUND AND OBJECTIVES: Traumatic intracranial aneurysms (TICAs) are highly unstable lesions that may rupture within minutes after formation or remain quiescent for several weeks and manifest with delayed hemorrhage and neurologic deterioration. mortality following a rupture may be 30% to 40%. Among all cerebral aneurysms, the incidence of TICAs is less than 1%; 20% to 30% of TICAs occur in children. methods AND MATERIALS: A child with a low-caliber craniocerebral gunshot wound deteriorated neurologically 12 days after the initial injury and emergency evacuation of an intracranial hematoma. A new massive left frontal hematoma was discovered, caused by the rupture of an unsuspected left pericallosal artery pseudoaneurysm. The new hematoma was evacuated, and the aneurysm was trapped using microsurgical techniques. RESULTS AND/OR CONCLUSIONS: A high index of suspicion should be maintained for delayed pseudoaneurysm genesis and rupture. A cerebral arteriogram should be obtained when significant subarachnoid hemorrhage or intraparenchymal hematomas are present, when missiles traverse major arteries, or when the pterional or cranioorbitofacial regions are violated. Treatment should be prompt. ( info)

10/32. Traumatic false aneurysm of the middle meningeal artery causing an intracerebral hemorrhage: case report and literature review.

    BACKGROUND: Traumatic false aneurysms of the meningeal arteries are rare. We report an unusual case of an intracerebral hematoma caused by the rupture of a traumatic aneurysm of the middle meningeal artery. CASE DESCRIPTION: A 64-year-old woman suffered a massive spontaneous intracerebral fronto-temporal hemorrhage. Cerebral angiogram revealed a pseudoaneurysm of the middle meningeal artery. At operation, a skull fracture was discovered in the vicinity of the aneurysm. The patient died the day after surgery. CONCLUSION: Although rare, traumatic meningeal aneurysms should be considered as a possible cause of cerebral hematoma. Because of their potential morbidity and mortality, they must be detected and treated rapidly. ( info)
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